1 introduction to bfhi and 10 steps of breastfeeding

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Ten steps of successful breast feeding

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1 introduction to bfhi and 10 steps of breastfeeding

  1. 1. INTRODUCTION TO BFHI AND 10 STEPS OF SUCCESSFUL BREASTFEEDING DR VARSHA ATUL SHAH Lecture 1
  2. 2. BABY FRIENDLY HOSPITAL INITIATIVE (BFHI)
  3. 3. What is BFHI • Worldwide programme of the World Health Organization and UNICEF, launched in 1991 following the Innocenti Declaration of 1990 • Global effort for improving the role of maternity services to enable mothers to breastfeed babies for the best start in life
  4. 4. Goals of the Baby-friendly Hospital Initiative • To transform maternity facilities through implementation of the “Ten steps” • To end the practice of distribution of free and low cost supplies of breast-milk substitutes to maternity wards and hospitals
  5. 5. BFHI • Global program • Sponsors World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) • HPB/MOH • To encourage, recognize maternity hospitals that offer an optimal level of care for infant feeding • Assists hospitals in giving mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies • Gives special recognition/accreditation to hospitals that have done so
  6. 6. PROTECT PROMOTE SUPPORT BREASTFEEDING
  7. 7. WHO/AAP RECOMMENDATION • Exclusive breastfeeding for the 1st 6 months • Continue BF after 6 months together with complementary food for up to 2 years or beyond • Begin skin to skin within 5 minutes of birth and BF within an hour of birth • “On demand", day and night • Avoid bottles or pacifiers
  8. 8. 10 Steps to Successful Breastfeeding
  9. 9. STEP 1 • Have a written policy that is routinely communicated to ALL health care staff
  10. 10. STEP 1:Why Breastfeeding Policy • Requires a course of action and provides guidance • Helps establish consistent care for mothers and babies • Provides a standard that can be evaluate
  11. 11. How Should It Be Presented? It should be: • Written in 4 languages (English, Chinese, Malay & Indian) • Posted or displayed where mothers and babies are cared for • Available to all staff caring for mothers and babies
  12. 12. STEP 2 • Train ALL health care staff in skills necessary to implement this policy
  13. 13. STEP 2:Who are Involved? • Nurse (20 hours) • Doctor (8 hours) • Allied health staff • Support staff - Clerk ,HCA, Cleaner (15-20 min) • ANYONE in contact with mothers IN ANYWAY OR OTHER STEP 2
  14. 14. STEP 2 Areas of knowledge • Advantages of breastfeeding • Risks of artificial feeding • Mechanisms of lactation and suckling • How to help mothers initiate and sustain breastfeeding • Assess a breastfeed • Managing breastfeeding difficulties • Hospital breastfeeding policies and practices
  15. 15. STEP 3• Inform all pregnant women about the benefits and management of breastfeeding
  16. 16. Anternatal Breastfeeding Education • Antenatal Class • Brochure / BF booklet/SSC • Screening of BF Video • To Document in patient’s notes once education have been given STEP 3
  17. 17. Content for Antenatal Education • Benefits of breastfeeding • Early initiation • Importance of rooming-in • Importance of feeding on demand • Importance of exclusive breastfeeding • Monitoring if baby is getting enough • Risks of artificial feeding, use of bottles & pacifiers (soothers, teats, nipples, etc.) STEP 3
  18. 18. STEP 4• Help mother initiate skin to skin contact for 1 hr within 5 min after delivery.
  19. 19. Dept Involved • Delivery Suite – All vaginal delivery – well baby & mother • Operating Theatre – EL LSCS • Special Care Nursery/NICU – When mother is well & baby is stable Posters and brochures will be displayed in these areas STEP 4
  20. 20. Why Skin to Skin & Early Initiation? • Increases duration of breastfeeding • Allows skin-to-skin contact for warmth and colonization of baby with maternal organisms • Provides colostrum as the baby’s 1st immunization • Takes advantage of the 1st hour of alertness • Babies learn to suckle more effectively • Improved developmental outcomes STEP 4
  21. 21. Skin to Skin & Early initiation at Delivery- How ? • Keep mother and baby together after delivery • Place baby on mother’s chest at least an hour • Initiate breastfeeding when baby shows readiness to suckle • Delay non-urgent medical routines for at least one hour STEP 4
  22. 22. STEP 5 • Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants Nurses Lactation Consultant
  23. 23. Basic Information &Technique • Breast care & massage • Latching technique – Modified cradle hold position – Football hold position – Lying position • Monitoring baby’s output • EBM techniques – Hand /pump STEP 5
  24. 24. Start expressing if unable to latch EBM techniques – Hand /pump Feed EBM with cup or spoon
  25. 25. STEP 6• Give newborn infants NO food or drink other than breastmilk ,unless medically indicated
  26. 26. THE PERFECT MATCH Adapted from: Pipes PL. Nutrition in Infancy and Childhood, Fourth Edition. St. Louis, Times Mirror/Mosby College Publishing, 1989. STEP 6 Quantity of colostrum per feed & the newborn stomach capacity
  27. 27. Colostrum is enough • Newborn and infant stomach capacities are perfectly matched to the amount of colostrum (about 200 ml/24 hours at day two) and mature milk (about 800-900 ml/24 hours at 1 year)
  28. 28. Why No Routine Supplement? Why No Bottle/teats? (avoid nipple confusion) Hungry crying baby Anxious mother Easy flow from bottle Less Breastmilk produced & Improper suckling pattern at breast Baby full – lazy about sucking
  29. 29. Why avoid supplementation? • Decreases eagerness to breastfeed, leading to reduced milk supply • Reduced mother’s confidence in breastfeeding leading to allergic sensitization of the baby • Increase chance of infection • If baby fed by bottle it can result in improper sucking pattern when breastfeeding • Involves unnecessary expense
  30. 30. RISK OF ARTIFICIAL FEEDING Baby • More likely to fall sick. • Increase risk of obesity • More diarrhoea and respiratory infections • More allergy and milk intolerance • Increased risk of chronic diseases • Decrease baby desire to breastfeed • Risk of necrotizing enterocolistis (NEC) in preterm Mother • Pregnant sooner • Increased risk of ovarian and breast cancer • Interferes with bonding • Decrease milk production
  31. 31. Acceptable Medical Reasons for use of Breast milk substitutes STEP 6
  32. 32. Medically Indicated for Supplementation- Infant Condition Infant who should not received breast milk or other milk except specialized formula : •Galactosemia •Maple syrup urine disease •Phenylketonuria (PKU) Infant for who, breast milk remains the best option but may need other food in addition to breast milk for limited period : •Very preterm infants (<32 weeks gestational age) •Very low birth weight infants (< 1500g) •Newborn infants at risk of hypoglycaemia
  33. 33. Medically Indicated for Supplementation MATERNAL CONDITION • Acceptable Feasible Affordable Sustainable and Safe Mother who may need to avoid breastfeeding permanently •HIV infection – if replacement feeding is AFASS AFASS=Acceptable feasible affordable, sustainable , safe Mother who may need to avoid breastfeeding temporarily •Severe illness - that prevents mother from caring for her infants •Herpes simplex virus Type 1 - if lesions on breasts •Maternal medication - Sedating psychotherapeutic drug - Radioactive iodine-131 -Cytotoxic chemotherapy •Substance abuse
  34. 34. Mother Who can Continue Breastfeeding • Breast Abscess • Hepatitis B- infants should get vaccine • Hepatitis C • Mastitis ( breast infection ) • TB-if treated and result –ve(FIND OUT )
  35. 35. STEP 7 1. Practise Rooming–In - allow mother & infants to remain together 24 hours a day.
  36. 36. Rooming-in Why? • Helps establish and maintain breastfeeding • Facilitates the bonding process • Enable demand feeding • Mother learns feeding cues • Mother learns to handle and comfort baby • Baby learns to recognize mother • Baby sleeps better • Baby exposed to less infections STEP 7
  37. 37. STEP 8• Encourage breastfeeding on demand. Frequently day and night, no restrictions on the length or frequency of feeds
  38. 38. Why demand feeding • Ensure a good milk supply • Results in less engorgment • Reduced crying and temptation to supplement • Ensure a contented baby
  39. 39. On demand, unrestricted breastfeeding Why? • Earlier passage of meconium • Lower maximal weight loss • Breast-milk flow established sooner • Larger volume of milk intake on day 3 • Less incidence of jaundice From: Yamauchi Y, Yamanouchi I. Breast-feeding frequency during the first 24 hours after birth in full-term neonates. Pediatrics, 1990, 86(2):171-175. STEP 8
  40. 40. STEP 9 • Give NO artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  41. 41. Alternatives to Artificial Teats • Cup • Spoon • Finger feeding • Tube feeding at breast STEP 9
  42. 42. STEP 10• Foster the establishment of Breastfeeding Support Groups and refer mothers to them on discharge from the hospital or clinic.
  43. 43. Support Can Includes: • Early postnatal or clinic check up • Home visits • Telephone calls • Community services • Outpatient breastfeeding clinics • Peer counseling programmes • Mother support groups • Family support system
  44. 44. Support : KKH • KK Ask-a-Nurse Service 8am to 12midnight daily 1900 556 8773 • Lactation clinic 6225 5554 • Postnatal Home Care • Mother to mother sharing session EXTERNAL BreastFeeding Mothers’ Support Group 6339 3558 Joyful Parenting and Breast-Feeding 6488 0286 Association for Breastfeeding Advocacy (ABAS) www.abas.org.sg
  45. 45. Best Videos • http://vimeo.com/28619032 • http://www.youtube.com/watch? v=Cuu8UEXzVQ0&feature=em- share_video_user
  46. 46. The International Code of Marketing of Breast milk Substitutes
  47. 47. • Protection, promote and support of breastfeeding • Ensure the proper use of breast-milk substitutes, when necessary, • Provide adequate information about infant feeding • Prohibit the advertising or any other form of promotion of breastmilk substitutes. AIM
  48. 48. Why No Free Milk Samples from Formula Companies • Prohibited by the code • Discourage exclusive breastfeeding • Encourages mother to supplement baby • It makes the mother think that the facility approves giving formula and certain brand • Some mothers may not be able to afford formula after samples are used up
  49. 49. Regulating Breastmilk Substitutes • No Advertising of breast milk substitutes or other products to the public
  50. 50. Regulating Breastmilk Substitutes • No company personnel to contact /advise mothers • No free samples to mother
  51. 51. Regulating Breastmilk Substitutes • No promotion in heath services • No donation of free or subsidized supplies of breast milk substitutes or other products in any part of the heath care system. • Since Jan 2012 ,all ready to feed formula have to be purchased all Singapore Hospital
  52. 52. Regulating Breastmilk Substitutes • No gifts of personal samples to heath workers • No picture of infants or other pictures or text idealizing artificial feeding on labels of products
  53. 53. Regulating Breastmilk Substitutes • Information to health workers should be scientific and factual • Information in artificial feeding should explain benefits of breastfeeding and costs/dangers associated with artificial breastfeeding Important notice: Breastmilk is the Best for babies………….
  54. 54. Regulating Breastmilk Substitutes • No sponsorship of space , equipment or education materials produced by companies when teaching mothers about infant feeding. • Unsuitable products such as sweeten condensed milk, should not be promoted for babies .
  55. 55. What you can do • Remove poster that advertise formula, tea juice or baby cereal, bottles and teats ,any new poster. • Refused to accept free gifts from companies with breast milk substitutes or related supplies • Refused to allow free samples, gift, or leaflets to be given to mothers • Ensure breast milk substitutes in hospital out of sight of pregnant women and mothers.
  56. 56. What you can do • No group teaching of artificial formula preparation to pregnant women. • Provide individual private teaching of formula use postnatally when a baby has a need for it • Report breaches of the code to appropriate authorities (SIFECS code) • Accept only product information from companies that is scientific and factual, not marketing material.
  57. 57. Communication scenario-Total 15 minutes • 2 minutes to read the question and organise thought • 9 minutes for communicating with patient • 1st alarm at 7 minutes when 2 minutes are left • 4 minutes for the feedback
  58. 58. BF and Formula
  59. 59. Communication Scenario-1• You are MO on call. • You are talking to G4P3, 30 years old single parent Lisa, who had divorced 7 months ago, who has 2 previous well baby girls age 4 and 2 years old. She had mixed fed both babies only for 4 weeks and full formula feeding since 2 months of age. Mother delivered at 40 weeks, baby boy by NVD yesterday. Lactation C, OG and NN doctor have both talked with her about exclusively breastfeeding her baby boy. • Although she knows it’s probably best for the baby, she is not sure if she wants to give full breastfeeding since she will be going to work after the baby is born. Being single mother, and it will be pretty tough to make ends meet with a new baby unless she works. • A friend told her, it was possible to pump her milk but that sounds like it could be pretty hard and would take too much time. • As such she does not feel formula feeds are harmful, since she was not also breastfed as baby, was told by her mum and as such she is doing fine.
  60. 60. Your role is to: 1. Ask open-ended questions to find out her thoughts and feelings about breastfeeding. 2. Use probes to better understand what she means. 3. Affirm her feelings. 4. Your role is to communicate benefits of breastfeeding and harmful effects of formula feeding.
  61. 61. Multiple Choice Question?
  62. 62. Question 1 What are the practices or routines done in delivery suite or postnatal ward that can help mothers to breast feed successfully ? All the answers are correct EXCEPT . 1. Start skin contact within 5 minutes after delivery and early initiation of breastfeeding 2. 24 hours rooming in day and night 3. Helping mothers to position and attach babies 4. Use bottles teats to supplement baby when baby is hungry
  63. 63. Question 2 Why is it important to avoid giving supplement or formula to a breastfed baby unless medically indicated? All the answers are correct EXCEPT 1. Mother will not empty the breast, leading to reduced milk supply and engorgement 2. Reduced mother’s confidence in breastfeeding, leading to formula feeding baby 3. If baby fed by bottle it can result in improper sucking pattern and latching when breastfeeding 4. Decreased risk of diarrheal and respiratory infection
  64. 64. Question 3 These policies or practices are being done in the hospital that can help mother to have a better chance to breastfeed baby successfully, all are true except: 1.Early skin to skin contact True/False 2.Early start to breastfeeding True/False 3.Providing mother with assistance in breastfeeding True/False 4.Leave baby in nursery at night, to provide rest True/ False 5.Feed baby on demand -day and night True/ False 6.Use cup feeding as alternative True/ False 7.Exclusive breastfeeding ( no BMS) True/False 8.Referring mother to support networks True/False
  65. 65. Question 4 Why is demand feeding important for successful breastfeeding all are true except.. 1. Mother will be able to supplement baby with breastfeeding 2. Mother will have good milk supply and result in less engorgement 3. Increase weight loss in baby 4. Help ensure a contented baby 5. Reduces crying and temptation to supplement
  66. 66. Question 5 Why do we encourage mother to room in with baby? 1. Mother can bond easily; can recognize hunger cues and can do demand feeing and baby is exposed to fewer infections. 2. Mother will be able to bottle feed baby easily 3. Confinement nanny/maid will be able to feed baby day and night such that mum can rest 4. Relatives can see the baby whenever they visit. 5. Parents do not have to walk to nursery to see the baby 6. Siblings can bond with baby
  67. 67. Question 6 If a colleague ask you why it is important not to give mother free formula samples from the infant formula companies, what reasons could you give? 1.It encourage mixed feeding, makes breastfeeding more difficult and makes the mother think that the facility approve giving formula and certain brand . 2.Mother will be able to choose which brand of formula to buy. 3.Mother will have less engorgement if baby is fed on formula. 4.Mother will have an increase in milk supply .
  68. 68. Question 7 Where can you get help if you have questions about feeding baby after you return home. All the following correct except 1. Get help from the hospital lactation consultant 2. Get help from a health professional 3. Call a helpline 4. Get help from a mother support group or a peer/lay counselor. 5. Get help from mother who is feeding fromula
  69. 69. Question 8 Step 4 of BFHI-Help mother initiate skin to skin contact for 1 hr within 5 min after delivery. Which dept is not involved in step 4 . 1. Del suite , 2. operating theatre 3. Special case nursery 4. Catering dept
  70. 70. Question 9 Step 5:Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants .What are the basic information & technique to teach mother all are true except .. 1.Breast care & massage 2.Latching technique 3.Monitoring baby’s output 4.EBM techniques 5.Show her how to prepare formula sterile way
  71. 71. Question 10 Which is not an alternative to feed baby 1.Cup 2.Spoon 3.Teat feeding 4. Tube feeding at breast
  72. 72. Answers • 1-4 • 2-3 • 3-4 • 4-3 • 5-1 • 6-1 • 7-5 • 8-4 • 9-5 • 10-3
  73. 73. References: • Evidence for the ten steps to successful breastfeeding. Geneva, World Health Organization,1998.http://www.who.int/nutrition/publications/infantfeeding/evidence_ ten_step_eng.pdf http://whqlibdoc.who.int/publications/2004/9241591544_eng.pdf. • Pipes PL. Nutrition in Infancy and Childhood. Boston, Massachusetts, Times Mirror/Mosby, 1989. • Yamauchi Y, Yamanouchi I. Breast-feeding frequency during the first 24 hours after birth in full-term neonates. Pediatrics, 1990, 86 (2):171-175. • World Health Organization.The optimal duration of exclusive breastfeeding :report of an expert consultation .Geneva:WHO; 2001. http://www.who.int/nutrition/publications/optimal_duration_of_exc_bfeeding_report_ eng.pdf • World health Organization. Evidence for 10 steps to successful breastfeeding .Geneva: WHO;1998. • Asole, S., Spinelli, A. , Antinucci L.E., and Lallo., D.D.
  74. 74. • Albernaz E, Giugliani ERJ, Victora CG. Supporting breastfeeding: a successful experience. J Hum Lact, 1998, 14(4):283-285. • Breastfeeding and the use of water and teas. Division of Child Health and Development, Update, No.9. Geneva, World Health Organization, reissued November 1997. • Cattaneo A, Buzzetti R. Effect on rates of breast feeding of training for the Baby Friendly Hospital Initiative. BMJ, 2001, 323:1358-1362. • Coutsoudis A, Kubendran P, Kuhn L, Spooner, E, Tsai W, Coovadia, HM. South African Vitamin A Study Group. Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS, 2001 Feb 16: 15(3):379-387. • Christensson K, Siles C, Moreno L, et al. Temperature, metabolic adaptation and crying in healthyfull-term newborns cared for skin-to-skin or in a cot. Acta Paediatr, 1992, 81:481-493. • DeCarvalho M, Klaus MH, Merkatz RB. Frequency of breast-feeding and serum bilirubin concentration. Am J Dis Child, 1982, 136:737-738. • DeCock KM, Fowler MG, Mercier E et al. Prevention of mother-to-child HIV transmission in resource poor countries. JAMA, 2000, 238 (9):175-82.DeChateau P, Wiberg B. Long term effect on mother-infant behavior of extra contact during the first hour postpartum. Acta Paediatr, 1977, 66:145-151. • Guidelines concerning the main health and socioeconomic circumstances in which infants have to befed on breast-milk substitutes. In: Thirty-Ninth World Health Assembly [A39/8 Add.1-10 April 1986],pp. 122-135, Geneva, World Health Organization, 1992. • Guise, J-M, Palda V, Westhoff C, Chan BKS, Helfand M, Lieu T. The effectiveness of primary carebased interventions to promote breastfeeding: Systematic evidence review and meta-analysis for the US preventive services task force. Annals of Family Medicine, 2003, 1(2):70-78. • Haider R et al. Breast-feeding counselling in a diarrhoeal disease hospital. Bulletin of the World Health Organization, 1996, 74(2):173-179. • Haider R, Kabir I, Huttly S and Ashworth A. A training peer counselors to promote and support exclusive breastfeeding in Bangladesh. J Hum Lact, 2002, 18:7-12.
  75. 75. References: • Righard L, Alade MO. Effect of delivery room routines on success of first breast-feed. Lancet, 1990,336: 1105-1107. • Righard L, Alade MO. Sucking technique and its effect on success of breastfeeding. Birth, 1992,19(4):185-189. • Saadeh RJ, Akré J. Ten steps to successful breast- feeding: a summary of the rationale and scientific evidence. Birth, 1996, 23(3):154-160.
  76. 76. Reference : international code• Global Strategy for Infant and Young Child Feeding. Geneva, World Health Organization, 2003. (http://www.who.int/nutrition/publications/infantfeeding/en/index.html;http://www.who.int/childadolescent- health/NUTRITION/global_strategy.htm). • Global strategy for infant and young child feeding: The optimal duration of exclusive breastfeeding.Fifty-fourth World Health Assembly, Provisional agenda item 13.1, A54/INF.DOC./4. Geneva, World Health Organization, 1 May2001.(http://www.who.int/gb/EB_WHA/PDF/WHA54/ea54id4.pdf). • Horton S, Sanghvi T, Phillips M, Fiedler J, Perez-Escamilla. Breastfeeding promotion and priority setting in health. Health Policy and Planning, 1996, 11(2):156-168. • International Baby Food Action Network. Protecting infant health: A health workers’ guide to the international code of marketing of breast-milk substitutes. 7th ed. Penang, Malaysia, IBFAN, 1993. • International code of marketing of breast-milk substitutes. Geneva, World Health Organization, 1981. • Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding A systematic review.Geneva, World Health Organization, 2002 (WHO/NHD/01.08;WHO/FCH/CAH/01.23). • New data on the prevention of mother-to-child transmission of HIV and their policy implications.Conclusions and recommendations. WHO technical consultation on behalf of the UNFPA/UNICEF/WHO/UNAIDS Inter- Agency Task Team on Mother-to-Child Transmission of HIV.Geneva, 11-13 October 2000. Geneva, World Health Organization, 2001 (WHO/RHR/01.28).
  77. 77. Reference : international code • Protecting, promoting and supporting breastfeeding: The special role of maternity services. A joint WHO/UNICEF statement. Geneva, World Health Organization, 1989. • Report of the expert consultation on the optimal duration of exclusive breastfeeding, Geneva,Switzerland, 28-30 March 2001. Geneva, World Health Organization, 2001(WHO/NHD/01.09;WHO/FCH/CAH/01.24). • Resolution WHA 39.28: Infant and Young Child Feeding. Geneva, World Health Organization, 1992. • Resolution WHA 47.5: Infant and Young Child Nutrition. Geneva, World Health Organization, 1994 • Saadeh R et al., eds. Breastfeeding: the technical basis and recommendations for action. Geneva,World Health Organization, 1993 (WHO/NUT/MCH/93.1). • The Baby-friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, Section 1:Background and Implementation; Section 2: Strengthening and sustaining BFHI: A course for decision-makers; Section 3:Breastfeeding Promotion and Support in a Baby- friendly Hospital; a 20-hour course; Section 4:Hospital Self-Appraisal and Monitoring; Section 5: External Assessment and Reassessment, New York, New York, UNICEF, and Geneva, WHO, 2008. (http://www.unicef.org/nutrition/index_24850.html?q=printme). • The International Code of Marketing of Breast-milk Substitutes: Frequently Asked Questions, Geneva, World Health Organization, 2006. (http://www.who.int/child-adolescenthealth/publications/NUTRTION/ISBN_92_4_159429_2.htm).
  78. 78. Thank You!

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